A clinical pathway reduced length of stay, time to ambulation, and complications after hip and knee arthroplasty

Question Does the use of a clinical pathway improve patient outcomes after hip or knee arthroplasty?

Design

Randomised, unblinded, controlled trial with ≥3 months follow up.

Setting

A tertiary referral hospital in Melbourne, Victoria, Australia.

Patients

175 patients who had hip or knee arthroplasty between January 1996 and December 1997. 12 patients (6.9%) were excluded after
randomisation because they were having revision arthroplasty, simultaneous bilateral joint arthroplasty, arthroplasty for
acute trauma, or complex tumour surgery. The remaining 163 patients (mean age 66 y, 66% women) completed ≥3 months of follow
up.

Intervention

92 patients were allocated to the clinical pathway group and 71 were allocated to the control group. Patients in the clinical
pathway group received “proactive” treatment whereby specific daily goals were set for the patient and the healthcare team.
A written protocol identified milestones to be achieved, tests …